Red flag: If provider documents cause, do this instead.

Do you have the “unspecified jaundice” code 774.6 memorized? That code will be but a memory when ICD-10 takes effect on Oct. 1, 2013. Take a look at how your jaundice coding will change in less than two years.

Current way: Under ICD-9 rules, you have just one code for unspecified neonatal jaundice, 774.6. You report this code unless the physician identifies a cause for the jaundice (such as being due to breast milk inhibitors, which would be 774.39). In the majority of cases, however, infants’ cases of jaundice are unspecified in nature and you code them with 774.6.

ICD-10 Changes: When the ICD-10 transition takes place, you will fortunately benefit from a one-to-one transition for your unspecified jaundice cases and you’ll turn to P59.9 (Neonatal jaundice, unspecified) when the physician documents that a patient has jaundice that isn’t due to any specific cause. If a cause is identified in the notes, you’d report that instead. For instance, if the patient’s jaundice is due to breast milk inhibitor, under ICD-10 you’d report P59.3. However, most jaundice cases fit into the “unspecified” territory.

Documentation: As in the past, physicians have needed to document whether a patient’s jaundice is caused by a more specific condition, but if the pediatrician simply documents “neonatal jaundice,” P59.9 will be your best option.

Coder Tips: Scratch out 774.6 on your superbills as Oct. 1, 2013 closes in, and replace it with the new ICD-10 code P59.9.

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Your anesthesiologist renders service which is more than the average, so you would append modifier 23 (Unusual anesthesia) to the procedure code. Though this doesn’t affect your reimbursement, payers do have rules regarding modifier 23’s use. These four steps will help you make sure that your claim meets certain criteria and won’t get you a denial.

1. Know the Descriptor

The abbreviated descriptor of modifier 23 in CPT®’s front cover is basic enough: It’s just “Unusual anesthesia.” But if you would read the full description in Appendix A more closely, you’ll get more details that you should consider:

“Occasionally, a procedure, which usually requires either no anesthesia or local anesthesia, because of unusual circumstances must be done under general anesthesia. This circumstance may be reported by adding the modifier -23 to the procedure code of the basic service.”

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Say good-bye to differing methods for determining a newborn’s age. The just released CPT® Assistant November 2011 has ended the longstanding debate on whether to count the day a baby is born as Day 1 or the day after birth as Day 1. Neonatal, pediatric, and hospitalist coders will all rejoice at the standardized approach, which should reduce denials for neonatal critical care (99368, 99369) and intensive care (99471, 99472, 99477) services.

Stay up to date with the latest AMA guidance handed down in the most recent CPT® Assistant newsletter right in SuperCoder.com. Search for any of these codes for new articles on:

• Atherectomy/Thrombectomy: 37225, 37227, 37229, 37231, 37233, 37235, 37184-37188, 75898, 76000, 76001 
•  Balloon assist device: 33967, 33968, 33970, 33971, 33973, 33974

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If you’ve been choosing your foreign-body removal (FBR) code based on the type of instrument the ophthalmologist used, it’s probable that you may be reporting the incorrect code — and collecting the wrong payments. This article tells the truth behind this and four other FBR myths that cause your ophthalmology coding colleagues to err frequently.

Myth #1: The type of instrument the ophthalmologist uses determines what foreign-body removal code to report.

Reality: The codes in the FBR code series (65205-65222) do not mention any particular instrument for removal of the FB. However, CPT® code 65222 (Removal of foreign body, external eye; corneal, with slit lamp) does indicate the equipment used to ease the viewing of the affected area. You should select a code based on the specific location and level of penetration of the FB in the eye.

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You might frequently observe mesh placement during hernia repair, but you cannot always bill this procedure separately. Read on to know when to report this.

1. Claim Placement With Incisional/Ventral Hernia

You may report placement of mesh (+49568, Implantation of mesh or other prosthesis for incisional or ventral hernia repair) separately only when the surgeon repairs an incisional or ventral hernia.

Know the details: Report 49568 with 49560 (Repair initial incisional or ventral hernia; reducible), 49561 (… incarcerated or strangulated), 49565 (Repair recurrent incisional or ventral hernia; reducible) and 49566 (… incarcerated or strangulated) when the surgeon documents mesh placement during the hernia repair.

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Question: Our anesthesiologist participated in a procedure for the arthroscopic release of adhesions to a patient’s shoulder that included manipulation. What do I need to include to report this correctly?

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Getting denials for your developmental screening claims? Don’t lose hope; simply add this tool to your basket and fight the zero-reimbursement situations with ease.

Testing vs. Screening

Annual CPT® updates always bring surprises for you. They can either help your practice substantially or threaten to bring your revenue down. Unfortunately, that’s what’s been happening for numerous pediatric practices that have been affected by the recent changes to the developmental screening code 96110 (Developmental screening, with interpretation and report, per standardized instrument form).

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Little changes from ICD-9 to ICD-10 for this condition.

Your surgeon may diagnose a peritoneal abscess when a procedure such as abdominal paracentesis confirms a pocket of infected fluid and pus within the abdominal cavity.

That’s when you’ll turn to 567.22 (Peritoneal abscess) to describe the diagnosis. But when ICD-9 shifts to ICD-10 on Oct. 1, 2013, you’ll need to report the condition with K65.1 (Peritoneal abscess).

Code cause, if known:

PS: To subscribe to The Coding Institute’s ICD-10 Coding Alert, Click Here

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As per the National insurer data, every year physicians downcode E/M visits amounting to more than $1 billion. That’s the money physicians have been leaving on the table by reporting a lower-level E/M claim than they should have. Here’s why you must file claims based on the physician’s documentation instead of “playing it safe” with lower-end codes.

1. Staying Low Doesn’t Keep You Below Radar

If you believe that reporting lower level E/M codes can help you fend off an audit, remember this: Reporting all low-level codes will also get a payer’s attention, because reviewers will wonder why your physician never offers high-level examinations.

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Coders for ambulatory surgical centers, emergency departments, inpatient hospitals, and anesthesiologists have been loving their own specialty physician coder corners on SuperCoder and now they have more to rave about …  Ambulatory payment classification (APC) codes, diagnostic related groupers (DRGs), anesthesia CROSSWALK®, anesthesia Reverse CROSSWALK®, and Relative Value Guide® (RVG) are all fully integrated in SuperCoder’s search. That means, you can search by code or keyword and get all the CPT® to APC or DRG or anesthesia fees you need all on one page. DRG Coder also crosswalks ICD-9 volume 1 and 3 codes to DRGs. Anesthesia Coder ‘0’ codes include anesthesia calculators, Reverse CROSSWALK®, and RVG. And coming soon both DRG Coder and Outpatient Facility Coder will feature their own OPPS- and IPPS-specific advice.

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